Medicaid enrollment among 30 leading health plans rose 13% to 21.8 million in 2012, according to a tally in Health Plan Market Trends. The nation’s largest for-profit Medicaid plan is WellPoint, with 4.6 million members, up 144% largely from the acquisition of Amerigroup. UnitedHealth is the next largest Medicaid plan, with 3.8 million members in 2012, up 6%. Centene was third at nearly 2.6 million, up 40%. Other Medicaid plans with more than 1 million members included Molina, WellCare and Health Net.
Poignant comments from Oregon Medicaid lottery winner Mary Carson, 55, commenting on the recent study suggesting the program had “no statistically significant effect on measured blood pressure, cholesterol or…diabetic blood sugar control.”
From a blog post:
I lost 40 pounds the first year, regained 15, and lost another 10 the next year. Now my doctor wants me to try for another 10 pound loss. I have gone from 3 blood pressure medicines to 1, and that’s at a half dose. This whole time my blood pressure stayed the same, but dropping 2 pills and keeping the same score is a health upgrade. My blood sugar is still pre-diabetic, but diabetes is a progressive disease. If you keep your blood sugar at the same level for 2 years, you are making progress with managing diabetes. The study would have found me to make no progress, but my doctor thinks I have improved.
The last point is that diabetes and cholesterol are both food-based diseases. The Oregon Medicaid project enrolled very poor adults….So none of us have access to unlimited fresh fruit and low fat meat. We still eat nothing but carbs for most meals….
What I would like to see is a study that shows the changes in these measurements over a 2 year period for people who have insurance. People with insurance for the last 20 years are not always improving their health, either.
And from the Washington Post
Some people have completely lost track of what health insurance is supposed to be. We’re talking about somebody being able to get their broken arm fixed if they fall out of a tree….
One of the things you get in Oregon is you get your teeth cleaned and X-rayed once a year. I hadn’t been to the dentist in six or eight years except to have a tooth pulled. So it was really nice to have my teeth cleaned and find out I don’t have cavities and don’t need my teeth pulled. My father died of melanoma and there’s a lot of melanoma in my family—one of my sons had skin cancer when was he was 15—and so that’s a worry. Being able to go to the doctor and have my moles checked was a big weight off my mind. I’m a lot surer I’m going to be able to make it to 70 without being crippled or in a wheelchair and not being able to take care of myself.
And there’s something about just feeling like you’re part of regular life. There’s a lot of emphasis on how everyone should be healthy and everyone should live longer, and you don’t want to be a burden on society. If you don’t have medical insurance, you’re kind of not part of that. It’s hard to explain, but there’s an element of participating in society that being able to go to the doctor gives you. Everybody always asks everyone how you’re doing, and to be able say “My doctor says I’m doing really well,” that’s nice, instead of being in a group of people and saying, “Well, I don’t really go to doctors.”
The results of Oregon’s randomized controlled Medicaid trial change nothing for health plans banking on dramatic membership gains from an expanded Medicaid program. Despite the spin from conservatives and liberals alike, the findings are mixed and unlikely to result in any major policy shifts. If anything, the results favor expansion.
The headline finding is that for people on Medicaid for two years, there is “no statistically significant effect on measured blood pressure, cholesterol or…diabetic blood sugar control.” That’s hardly good new for liberals seeking a clear indication that Medicaid improves a person’s health across the board.
But it’s not the failure conservatives are portraying either. The study also finds, “Medicaid coverage lowered rates of depression and nearly eliminated catastrophic out of pocket medical expenditures.”
The study adds that compared to being uninsured, Medicaid increases the use of physician services, prescription drugs, preventive care and screenings, the probability of being diagnosed with diabetes, and the likelihood of having a usual place of care.
By the way, the study isn’t necessarily saying that Medicaid didn’t improve people’s health, but rather that “our power to detect changes in health was limited by the relatively small numbers of patients with these conditions.”
What the study says to me is that Medicaid is doing pretty much what insurance is supposed to do: help people get access to care and protect them from financial ruin.
The fact that there wasn’t a meaningful improvement in certain health measures may indeed indicate very real shortcomings in the Medicaid program. But as the study suggests, the result may also indicate that there isn’t always a clear “connection between insurance coverage and observable improvements in our health metrics.”
From Health Affairs:
During and immediately after the recent recession, national health expenditures grew exceptionally slowly. During 2009–11 per capita national health spending grew about 3 percent annually, compared to an average of 5.9 percent annually during the previous ten years. Policy experts disagree about whether the slower health spending growth was temporary or represented a long-term shift. This study examined two factors that might account for the slowdown: job loss and benefit changes that shifted more costs to insured people. Based on an examination of data covering more than ten million enrollees with health care coverage from large firms in 2007–11, we found that these enrollees’ out-of-pocket costs increased as the benefit design of their employer-provided coverage became less generous in this period. We conclude that such benefit design changes accounted for about one-fifth of the observed decrease in the rate of growth. However, we also observed a slowdown in spending growth even when we held benefit generosity constant, which suggests that other factors, such as a reduction in the rate of introduction of new technology, were also at work. Our findings suggest cautious optimism that the slowdown in the growth of health spending may persist—a change that, if borne out, could have a major impact on US health spending projections and fiscal challenges facing the country.
Twelve publicly traded health plans posted a combined 6.9% decline in first quarter net income to $3.6 billion. However, excluding Cigna, which took a big charge related to its run-off reinsurance business, combined net income among the remaining 11 companies rose 2%.
If you count only the health insurance operations of Aetna, Cigna and UnitedHealth in the total, net income among the 12 companies rose 4.2%. Gainers included Health Net, Humana, Molina and WellPoint. Losers included Aetna, Centene, UnitedHealth and WellCare. Net margin among the 12 companies—again including only the healthcare operations of Aetna, Cigna and United—was 4.1%, down about 30 basis points from a year ago.
Investors are keeping a close eye on the quarterly performance of health plans in the lead-up to the full implementation of ObamaCare and amidst projections by some analysts that the industry is in an underwriting down-cycle.